Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 8;21(1):1044.
doi: 10.1186/s12879-021-06755-8.

Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study

Knut Eirik Eliassen #  1 , Lukas Frans Ocias #  2   3 , Karen A Krogfelt  2   4 , Peter Wilhelmsson  5   6 , Susanne Gjeruldsen Dudman  7   8 , Åshild Andreassen  9   10 , Morten Lindbak  11 , Per-Eric Lindgren  5   6
Affiliations

Tick-transmitted co-infections among erythema migrans patients in a general practice setting in Norway: a clinical and laboratory follow-up study

Knut Eirik Eliassen et al. BMC Infect Dis. .

Abstract

Background: Erythema migrans (EM) is the most common manifestation of Lyme borreliosis. Here, we examined EM patients in Norwegian general practice to find the proportion exposed to tick-transmitted microorganisms other than Borrelia, and the impact of co-infection on the clinical manifestations and disease duration.

Methods: Skin biopsies from 139/188 EM patients were analyzed using PCR for Neoehrlichia mikurensis, Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Follow-up sera from 135/188 patients were analyzed for spotted fever group (SFG) Rickettsia, A. phagocytophilum and Babesia microti antibodies, and tested with PCR if positive. Day 0 sera from patients with fever (8/188) or EM duration of ≥ 21 days (69/188) were analyzed, using PCR, for A. phagocytophilum, Rickettsia spp., Babesia spp. and N. mikurensis. Day 14 sera were tested for TBEV IgG.

Results: We detected no microorganisms in the skin biopsies nor in the sera of patients with fever or prolonged EM duration. Serological signs of exposure against SFG Rickettsia and A. phagocytophilum were detected in 11/135 and 8/135, respectively. Three patients exhibited both SFG Rickettsia and A. phagocytophilum antibodies, albeit negative PCR. No antibodies were detected against B. microti. 2/187 had TBEV antibodies without prior immunization. There was no significant increase in clinical symptoms or disease duration in patients with possible co-infection.

Conclusions: Co-infection with N. mikurensis, A. phagocytophilum, SFG Rickettsia, Babesia spp. and TBEV is uncommon in Norwegian EM patients. Despite detecting antibodies against SFG Rickettsia and A. phagocytophilum in some patients, no clinical implications could be demonstrated.

Keywords: Antibiotic guidelines; Clinical microbiology; General practice; Tick-borne infections.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a Flowchart describing molecular analyses of EM-patients. b Flowchart describing serological analyses of EM-patients. *Day 14 and 3-month sera were additionally analyzed for TBEV (187/188) and Bbsl (175/188), respectively. †Patients with detectable IgG in the screening sample also had the remaining study samples tested for antibodies against the corresponding microorganisms
See this image and copyright information in PMC

References

    1. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet Lond Engl. 2012;379(9814):461–473. doi: 10.1016/S0140-6736(11)60103-7. - DOI - PubMed
    1. Quarsten H, Skarpaas T, Fajs L, Noraas S, Kjelland V. Tick-borne bacteria in Ixodes ricinus collected in southern Norway evaluated by a commercial kit and established real-time PCR protocols. Ticks Tick-Borne Dis. 2015;6(4):538–544. doi: 10.1016/j.ttbdis.2015.04.008. - DOI - PubMed
    1. Jenkins A, Kristiansen BE, Allum AG, Aakre RK, Strand L, Kleveland EJ, et al. Borrelia burgdorferi sensu lato and Ehrlichia spp. in Ixodes ticks from southern Norway. J Clin Microbiol. 2001;39(10):3666–3671. doi: 10.1128/JCM.39.10.3666-3671.2001. - DOI - PMC - PubMed
    1. Larsson C, Hvidsten D, Stuen S, Henningsson AJ, Wilhelmsson P. “Candidatus Neoehrlichia mikurensis” in Ixodes ricinus ticks collected near the Arctic Circle in Norway. Parasit Vectors. 2018;11(1):620. doi: 10.1186/s13071-018-3168-y. - DOI - PMC - PubMed
    1. Mysterud A, Easterday WR, Qviller L, Viljugrein H, Ytrehus B. Spatial and seasonal variation in the prevalence of Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato in questing Ixodes ricinus ticks in Norway. Parasit Vectors. 2013;6:187. doi: 10.1186/1756-3305-6-187. - DOI - PMC - PubMed